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Sexually Transmitted Infections Treatment Guidelines, 2021


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Table 1 – STI Treatment Guidelines										Related Pages
					Cervical cancer screening and surveillance recommendations
Table 1
Population
Screening specifics
Guideline group, yr of recommendationUSPSTF, 2018
ACOG, 2016
ACS, 2020Persons at average risk
Age to start screening
21 yrs
21 yrs
25 yrsAge to end screening
65 yrs
65 yrs
65 yrsIf three consecutive negative cytology tests or two negative cytology plus HPV tests or two negative HPV tests (ACS) with the most recent within the previous 5 yrs and no abnormal tests within the previous 10 yrs (ACS) and no CIN 2 or CIN 3 within the previous 25 yrsScreening test options and intervals
Aged 21–65 yrs: Cytology alone every 3 yrs***or***Aged 21–29 yrs: Cytology alone every 3 yrs
Aged 30–65 yrs: Cytology plus HPV testing every 5 yrs***or***Aged 21–29 yrs: Cytology alone every 3 yrs
Aged 30–65: HPV testing alone every 5 yrs*
HPV testing alone every 5 yrs***or***Cytology plus HPV testing every 5 yrs***or***
Cytology alone every 3 yrsPreferred strategies
Cytology alone every 3 yrs and HPV testing alone every 5 yrs (equally preferred)
Cytology plus HPV testing every 5 yrs
HPV testing alone every 5 yrsPrevious hysterectomy with removal of cervix
Screening not recommended after hysterectomy for benign indications
Surveillance testing recommended for previous diagnosis of high-grade precancer, AIS, or cancerPersons with an immunocompromising medical condition† (e.g., HIV infection or solid organ transplantation)
Age to start screening
No specific recommendation
Within 1 yr of onset of sexual activity or, if already sexually active, within the first year after HIV or other immunocompromising medical condition diagnosis but no later than age 21 yrsAge to end screening
None; lifelong screening recommendedScreening test options and intervals
Aged 21–65 yrs: Cytology every year; after three consecutive annual normal cytology test results, screening can be every 3 yrs***or***Aged 21–29 yrs: Cytology every year
Aged 30–65 yrs: Cytology plus HPV testing every 3 yrsPrevious hysterectomy with removal of cervix
Not specifiedPersons within utero exposure to diethylstilbestrol§
Age to start screening
No specific recommendation
Not specified
No specific recommendationAge to end screening
Not specifiedScreening test options and intervals
Cytology alone annuallyPrevious hysterectomy with removal of cervix
Not specifiedPersons who have received HPV vaccination
No changes to the screening approaches above**Population**
**Screening specifics**
**ASCCP, 2019, and ACOG, 2020**Persons with a diagnosis of CIN 2 or CIN 3 (histologic HSIL¶) within the previous 25 yrs
Age to start screening
Not applicableAge to end screening
May end at age 65 yrs if CIN diagnosis ≥25 yrs ago and criteria for ending screening met, otherwise continue screening past age 65 yrs
Continued screening for ≥25 yrs after diagnosis is acceptable if patient is in good healthScreening test options and intervals
**Initial surveillance:**
HPV testing alone or cytology plus HPV testing at 6, 18, and 30 mos***or***
Cytology at 6, 12, 18, 24, and 30 mos**Long-term surveillance:**
HPV testing alone or cytology plus HPV testing every 3 yrs***or***
Cytology alone annually
Continue for ≥25 yrs from the initial CIN diagnosis, even if extends past age 65 yrs
Routine screening can resume after the posttreatment surveillance periodPrevious hysterectomy with removal of cervix
HPV testing alone or cytology plus HPV testing every 3 yrs***or***
Cytology alone annually
Continue for ≥25 yrs from the initial CIN diagnosis, even if extends past age 65 yrsSource: Perkins R, Guido R, Saraiya M, et al. Summary of current guidelines for cervical cancer screening and management of abnormal test results: 2016–2020. J Womens Health (Larchmt) 2021;30:5–13.
Abbreviations: ACS = American Cancer Society; ACOG = American College of Obstetricians and Gynecologists; AIS = adenocarcinoma in situ; ASCCP = American Society for Colposcopy and Cervical Pathology; CIN = cervical intraepithelial neoplasia; HPV = human papillomavirus; HSIL = high-grade squamous intraepithelial lesion; USPSTF = U.S. Preventive Services Task Force.
* Considered an alternative screening strategy by ACOG.
†Panel for Opportunistic Infections, ACOG, 2016.
§ACOG, 2016.
¶ Either by cytology or by histology; includes a persistent cytologic diagnosis of atypical squamous cells, cannot rule out HSIL.
							
					
						Page last reviewed:  July 22, 2021					Content source: 	Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention homeSTI Treatment Guidelines, 2021
Provider Resourcesplus icon
Customizable Announcement
Screening Recommendations
Tables of Evidence
Table of Contents
Summary and Introduction
Methods
Clinical Prevention Guidanceplus icon
STI and HIV Infection Risk Assessment
Primary Prevention Methods
Partner Servicesplus icon
Expedited Partner Therapy (EPT)
Reporting and Confidentiality
Retesting After Treatment to Detect Repeat Infections
Detection of STIs in Special Populationsplus icon
Pregnant Women
Adolescents
Children
MSM
WSW and WSWM
Transgender and Gender Diverse Persons
Persons in Correctional Facilities
HIV Infection: Detection, Counseling, and Referral
Diseases Characterized by Genital, Anal, or Perianal Ulcersplus icon
Chancroid
Genital Herpes
Granuloma Inguinale (Donovanosis)
Lymphogranuloma Venereum (LGV)
Syphilisplus icon
Primary and Secondary Syphilis
Latent Syphilis
Tertiary Syphilis
Neurosyphilis, Ocular Syphilis, and Otosyphilis
Syphilis Among Persons with HIV Infection
Syphilis During Pregnancy
Congenital Syphilis
Managing Persons Who Have a History of Penicillin Allergy
Diseases Characterized by Urethritis and Cervicitis
Chlamydial Infections
Gonococcal Infectionsplus icon
Gonococcal Infections Among Adolescents and Adults
Gonococcal Infections Among Neonates
Gonococcal Infections Among Infants and Children
*Mycoplasma genitalium*
Vulvovaginal Itching, Burning, Irritation, Odor or Dischargeplus icon
Bacterial Vaginosis
Trichomoniasis
Vulvovaginal Candidiasis
Pelvic Inflammatory Disease (PID)
Epididymitis
Human Papillomavirus (HPV) Infectionplus icon
Anogenital Warts
HPV-Associated Cancers and Precancers
Viral Hepatitisplus icon
HAV
HBV
HCV
Proctitis, Proctocolitis, and Enteritis
Ectoparasitic Infections
Sexual Assault and Abuse and STIsplus icon
Adolescents and Adults
Sexual Assault or Abuse of Children
References
Terms and Abbreviations Used in This Report
Workgroup Members
Timeline of STI Treatment Guidelines


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